European journal of physical and rehabilitation medicine
BACKGROUND: The factors that determine successful rehabilitation after lower limb amputation have... more BACKGROUND: The factors that determine successful rehabilitation after lower limb amputation have been widely investigated in the literature, but little attention has been paid to the type of prosthesis and clinical state of the residual limb, particularly the presence of open ulcers. AIM:The aim of this study was to investigate the effects of a vacuum-assisted socket system (VASS) in a sample of trans-tibial amputees with wounds or ulcers on the stump and to evaluate prosthesis use as a primary outcome. Secondary outcome measures were mobility with the prosthesis, pain associated with prosthesis use, and wound/ulcer healing. STUDY DESIGN:Randomized controlled study. SETTING: Inpatient. POPULATION: Twenty dysvascular transtibial amputees suffering from ulcers due to prosthesis use or delayed wound healing post-amputation were enrolled. METHODS:Participants were separated into two groups: the experimental group was trained to use a VASS prosthesis in the presence of open ulcers/wound...
European journal of physical and rehabilitation medicine, 2013
Adolescents with idiopathic scoliosis show a postural instability compared with healthy subjects.... more Adolescents with idiopathic scoliosis show a postural instability compared with healthy subjects. DESIGN TYPE. Case control study. Outpatient clinic of the Complex Operative Unit of Physical Medicine and Rehabilitation of Policlinico Umberto I Hospital. Thirteen patients (11 females and 2 males, mean age 13.3±1.7 years, mean Cobb angle 32±9, median Risser sign 2) and thirteen healthy adolescents (8 females and 5 males, mean age: 13.0±1.6 years) as age-matched control group were enrolled. Postural ability of the participants was assessed with stabilometry (under open eyes and closed eyes conditions), computing sway length, sway ellipse area, and sway velocities. Static and dynamic baropodometry (open eyes only) was used to measure the limb load, and to compute: walking speed, step length, step cadence and step width. The symmetry of left and right limb values was also investigated. Patient's group was characterized by significantly higher postural instability than control group (...
European journal of physical and rehabilitation medicine, 2013
Bilateral transfer, i.e. the capacity to transfer from one to the other hand a learned motor skil... more Bilateral transfer, i.e. the capacity to transfer from one to the other hand a learned motor skill, may help the recovery of upper limb functions after stroke. To investigate the motor strategies at the basis of sensorimotor learning involved in bilateral transfer. Randomized controlled trial. Neurorehabilitation Hospital. Eighty right-handed participants (65 ± 13 years old): 40 patients with subacute stroke, 40 control healthy subjects. Subjects performed the 9 hole-peg-test twice in an order defined by random allocation: first with low and then with high skilled hand (LS-HS) or the reverse (HS-LS). Time spent to complete the test and filling sequence were recorded, together with maximum pinch force (assessed using a dynamometer), upper limb functioning (Motricity Index), spasticity (modified Ashworth Scale), limb dominance (Edinburgh Handeness Inventory). As expected, in patients, the performance was found related to the residual pinch force (P<0.001), upper limb motricity (P=0...
European journal of physical and rehabilitation medicine, 2012
Low back pain is a worldwide health problem, affecting up to 80% of adult population. Psychologic... more Low back pain is a worldwide health problem, affecting up to 80% of adult population. Psychological factors are involved in its development and maintenance. Many clinical trials have evaluated the efficacy of different interventions for chronic non-specific low back pain. In this field, Back School program has been demonstrated effective for people with chronic non-specific low back. To evaluate the relationship between the effects of the Back School treatment and psychological features measured by MMPI-II of patients with chronic non-specific low back pain. A randomised controlled trial with three and six-month follow-up. Ambulatory rehabilitative university centre. Fifty patients with chronic non-specific low back pain out of 77 screened patients. Patients were randomly placed in a 3:2 form and were allocated into two groups (Treatment versus Control). The Treatment Group participated to an intensive multidisciplinary Back School program (BSG, N.=29), while the Control Group recei...
In breast cancer survivors, own body image may change due to physical and psychological reasons, ... more In breast cancer survivors, own body image may change due to physical and psychological reasons, worsening women's living. The aim of the study was to investigate whether body image may affect the functional and quality of life outcomes after a multidisciplinary and educational rehabilitative intervention in sixty women with primary nonmetastatic breast cancer who have undergone conservative surgery. To assess the quality of life was administered The European Organization for Research and Treatment of Cancer Study Group on Quality of Life core questionnaire, while to investigate the psychological features and selfimage were administered the following scales: the Body Image Scale, the Hamilton Rating Scale for Depression, and the State-Trait Anxiety Inventory. To assess the recovery of the function of the shoulder were administered: the Disabilities of the Arm, Shoulder, and Hand Questionnaire and the Constant-Murley Score. Data were collected at the baseline, at the end of the intervention, and at 3-month follow-up. We found a general improvement in the outcomes related to quality of life, and physical and psychological features after treatment (P < 0.001). During follow-up period, a higher further improvement in women without alterations in body image in respect of those with an altered self-perception of their own body was found (P = 0.01). In conclusion, the body image may influence the efficacy of a rehabilitative intervention, especially in the short term of follow-up.
Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in impro... more Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in improving motor performance in patients with chronic stroke, while some recent findings have reported conflicting results for the subacute phase. We aimed to verify whether upper extremity motor rehabilitation could be enhanced by treatment with tDCS administered before a rehabilitative session. Hand dexterity and force in 16 individuals with subacute stroke were assessed before (T0) and after anodal stimulation (T1) and after a successive session of motor rehabilitation (T2) in a double-blind, randomized, sham-controlled, crossover trial. To confirm the value of the device as a specific effector, behavioral tests were also administered. Anodal and sham stimulation plus rehabilitation significantly improved manual dexterity (repeated-measure Anova: A-tDCS: p = 0.005; S-tDCS: p = 0.042). Post hoc analysis revealed a significant stimulation effect only for A-tDCS (p = 0.013 between T0 and T1) a...
Foot drop is a quite common problem in nervous system disorders. Neuromuscular electrical stimula... more Foot drop is a quite common problem in nervous system disorders. Neuromuscular electrical stimulation (NMES) has showed to be an alternative approach to correct foot drop improving walking ability in patients with stroke. In this study, twenty patients with stroke in subacute phase were enrolled and randomly divided in two groups: one group performing the NMES (i.e. Walkaide Group, WG) and the Control Group (CG) performing conventional neuromotor rehabilitation. Both groups underwent the same amount of treatment time. Significant improvements of walking speed were recorded for WG (168±39%) than for CG (129±29%, P = 0.032) as well as in terms of locomotion (Functional Ambulation Classification score: P = 0.023). In terms of mobility and force, ameliorations were recorded, even if not significant (Rivermead Mobility Index: P = 0.057; Manual Muscle Test: P = 0.059). Similar changes between groups were observed for independence in activities of daily living, neurological assessments, and spasticity reduction. These results highlight the potential efficacy for patients affected by a droop foot of a walking training performed with a neurostimulator in subacute phase.
Control of gait is usually altered following stroke, and it may be further compromised by overexe... more Control of gait is usually altered following stroke, and it may be further compromised by overexertion and fatigue. This study aims to quantitatively assess patients' gait stability during six-minute walking, measuring upper body accelerations of twenty patients with stroke (64 ± 13 years old) and ten age-matched healthy subjects (63 ± 10 years old). Healthy subjects showed a steady gait in terms of speed and accelerations over the six minutes. Conversely, the patients unable to complete the test (n = 8) progressively reduced their walking speed (−22±11%, confidence interval CI 95% : −13, −29%, P = 0.046). Patients able to complete the test (n = 12) did not vary their walking speed over time (P = 0.493). However, this ability was not supported by an adequate capacity to maintain their gait stability, as shown by a progressive increase of their upper body accelerations (+5 ± 11%, CI 95% : −1; +12%, P = 0.010). Walking endurance and gait stability should be both quantitatively assessed and carefully improved during the rehabilitation of patients with stroke.
Vision can improve bipedal upright stability during standing and affect spatiotemporal parameters... more Vision can improve bipedal upright stability during standing and affect spatiotemporal parameters during walking. However, little is known about the effects of visual deprivation on gait dynamic stability. We have tested 28 subjects during walking under two different visual conditions, full vision (FV) and no vision (NV), measuring their upper body accelerations. Lower accelerations were found in NV for the reduced walking speed. However, the normalized accelerations were higher in the NV than in the FV condition, both in anteroposterior (1.05 ± 0.21 versus 0.88 ± 0.16, P = 0.001) and laterolateral (0.99 ± 0.26 versus 0.78 ± 0.19, P < 0.001) directions. Vision also affected the gait anteroposterior harmony (P = 0.026) and, interacting with the environment, also the latero-lateral one (P = 0.017). Directly (as main factor of the ANOVA) or indirectly (by means of significant interactions with other factors), vision affected all the measured parameters. In conclusion, participants showed an environment-dependent reduction of upper body stability and harmony when deprived by visual feedback.
Subjects affected by Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am... more Subjects affected by Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease have substantially impaired static and dynamic balance, leading to diminished functional ability. Conventional and innovative exercises have been suggested, but most of them were focused on motor features of posture and gait, deserving poor attention to perceptive aspects of balance. To evaluate the efficacy of the perceptive rehabilitation, based on perceptual surfaces, for postural balance (primary aim) and pain, depression and activity daily living. In this pilot study, we have treated 9 patients with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease undergone rehabilitation aiming to restoring their correct body midline perception, according a schema treatment - no treatment - treatment. During the rehabilitative intervention, both Tinetti balance score (p = 0.007 in both phases) and Tinetti gait score (p = 0.011 and p = 0.016, respectively), such as pain relief assessed by Visual Analogue Scale (p = 0.011, p = 0.010) were improved. Conversely in the phase of no-intervention, lasting the same amount of time, it was showed a significant reduction of Tinetti Balance score (p = 0.010) and no significant changes in terms of Tinetti Gait score and Visual Analogue Scale. These preliminary results highlighted the importance of introducing perceptive training into the exercises proposed to patients with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease for reducing both their static and dynamic balance impairments.
Upright gait is a peculiar characteristic of humans that requires the ability to manage upper bod... more Upright gait is a peculiar characteristic of humans that requires the ability to manage upper body dynamic balance while walking, despite the perturbations that are generated by movements of the lower limbs. Most of the studies on upright gait stability have compared young adults and the elderly to determine the effects of aging. In other studies, the comparison was between healthy subjects and patients to examine specific pathologies. Fewer researches have also investigated the development of upright gait stability in children. This review discusses these studies in order to provide an overview of this relevant aspect of human locomotion. A clear trend from development to decline of upright gait stability has been depicted across the entire lifespan, from toddlers at first steps to elderly. In old individuals, even if healthy, the deterioration of skeletal muscle, combined with sensorial and cognitive performance, reduces the ability to maintain an upright trunk during walking, increasing the instability and the risk of falls. Further, the pathological causes of altered development or of a sudden loss of gait stability, as well as the environmental influence are investigated. The last part of this review is focused on the control of upper body accelerations during walking, a particularly interesting topic for the recent development of low-cost wearable accelerometers.
Motor imagery and internal motor models have been deeply investigated in literature. It is well k... more Motor imagery and internal motor models have been deeply investigated in literature. It is well known that the development of motor imagery occurs during adolescence and it is limited in people affected by cerebral palsy. However, the roles of motor imagery and internal models in locomotion as well as their intertwine received poor attention. In this study we compared the performances of healthy adults (n = 8, 28.1 ± 5.1 years old), children with typical development (n = 8, 8.1 ± 3.8 years old) and children with cerebral palsy (CCP) (n = 12, 7.5 ± 2.9 years old), measured by an optoelectronic system and a trunk-mounted wireless inertial magnetic unit, during three different tasks. Subjects were asked to achieve a target located at 2 or 3 m in front of them simulating their walking by stepping in place, or actually walking blindfolded or normally walking with open eyes. Adults performed a not significantly different number of steps (p = 0.761) spending not significantly different time between tasks (p = 0.156). Children with typical development showed task-dependent differences both in terms of number of steps (p = 0.046) and movement time (p = 0.002). However, their performance in simulated and blindfolded walking (BW) were strictly correlated (R = 0.871 for steps, R = 0.673 for time). Further, their error in BW was in mean only of -2.2% of distance. Also CCP showed significant differences in number of steps (p = 0.022) and time (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), but neither their number of steps nor their movement time recorded during simulated walking (SW) were found correlated with those of blindfolded and normal walking (NW). Adults used a unique strategy among different tasks. Children with typical development seemed to be less reliable on their motor predictions, using a task-dependent strategy probably more reliable on sensorial feedback. CCP showed less efficient performances, especially in SW, suggesting an altered locomotor imagery.
In nature, many physical and biological systems have structures showing harmonic properties. Some... more In nature, many physical and biological systems have structures showing harmonic properties. Some of them were found related to the irrational number known as the golden ratio that has important symmetric and harmonic properties. In this study, the spatiotemporal gait parameters of 25 healthy subjects were analyzed using a stereophotogrammetric system with 25 retroreflective markers located on their skin. The proportions of gait phases were compared with , the value of which is about 1.6180. The ratio between the entire gait cycle and stance phase resulted in 1.620 ± 0.058, that between stance and the swing phase was 1.629 ± 0.173, and that between swing and the double support phase was 1.684 ± 0.357. All these ratios did not differ significantly from each other ( = 0.870, = 0.422, repeated measure analysis of variance) or from ( = 0.670, 0.820, 0.422, resp., t-tests). The repetitive gait phases of physiological walking were found in turn in repetitive proportions with each other, revealing an intrinsic harmonic structure. Harmony could be the key for facilitating the control of repetitive walking. Harmony is a powerful unifying factor between seemingly disparate fields of nature, including human gait.
Transcranial direct current stimulation (tDCS) is a noninvasive technique that is emerging as a p... more Transcranial direct current stimulation (tDCS) is a noninvasive technique that is emerging as a prospective therapy for different neurologic disorders. Previous studies have demonstrated that anodal and cathodal stimulation can improve motor performance in terms of dexterity and manual force. The objective of this study was to determine whether different electrodes' setups (anodal, cathodal, and simultaneous bilateral tDCS) provide different motor performance and which montage was more effective. As secondary outcome, we have asked to the patients about their satisfaction, and to determine if the bilateral tDCS was more uncomfortable than unilateral tDCS. Nine patients with stroke in subacute phase were enrolled in this study and randomly divided in three groups. Our results showed that tDCS was an effective treatment if compared to Sham stimulation (P = 0.022). In particular, anodal stimulation provided the higher improvement in terms of manual dexterity. Cathodal stimulation s...
Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehab... more Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehabilitation's efforts are tended to avoid long-term impairments, but, actually, the rehabilitative outcomes are still poor. Novel tools based on new technologies have been developed to improve the motor recovery. In this paper, we have taken into account seven promising technologies that can improve rehabilitation of patients with stroke in the early future: (1) robotic devices for lower and upper limb recovery, (2) brain computer interfaces, (3) noninvasive brain stimulators, (4) neuroprostheses, (5) wearable devices for quantitative human movement analysis, (6) virtual reality, and (7) tablet-pc used for neurorehabilitation.
La lombalgia cronica (LC) è una patologia molto diffusa con una prevalenza variabile dal 15% al 4... more La lombalgia cronica (LC) è una patologia molto diffusa con una prevalenza variabile dal 15% al 45% nella popolazione 1 . Circa il 90% delle persone lamenta un episodio algico lombare almeno una volta nella vita 2 e nel 5-8 % dei casi 3 è di marcata intensità. Sebbene la maggior parte delle LC si risolva spontaneamente nell'arco di uno o tre mesi, dopo circa un anno il 15% presenta una riacutizzazione della sintomatologia 4 .
Many studies have examined how children with cerebral palsy (CP) manage to walk, but few have inv... more Many studies have examined how children with cerebral palsy (CP) manage to walk, but few have investigated running, yielding controversial results. The aim of this study was to quantitatively assess gait ability and its stability in children with hemiplegic CP while running and walking. A group of 20 children with spastic hemiplegia due to CP (CPG, 5.1 ± 2.3 years old), and a group of 20 children with typical development (TDG, 5.9 ± 2.6 years old) underwent a 10-m walking/running test with a wearable triaxial accelerometer fixed to their lower trunk. Spatiotemporal gait parameters, root mean squares of upper body acceleration, and related harmonic and symmetry ratios were computed. Differences in gait speed were significantly higher during running ( - 19% for CPG with respect of TDG) than during walking ( - 14%, p = 0.028). Conversely, no significant changes were observed in terms of gait stability, and the differences in terms of gait harmony along anteroposterior axis recorded during walking ( - 43%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) disappeared during running ( + 3%, p = 0.834). During running, children with CP are slower than children with TD, but their gait was not less stable, and the harmony of their anteroposterior movements was even more similar to TDG than during walking.
The Journal of Rehabilitation Research and Development, 2012
The analysis of upper-body acceleration is a promising and simple technique to quantitatively ass... more The analysis of upper-body acceleration is a promising and simple technique to quantitatively assess dynamic gait stability. However, this method has rarely been used for people with stroke, probably because of some technical issues still not addressed. We evaluated the root-mean-square (RMS) and harmonic ratio of trunk accelerations for a group of 15 inpatients with subacute stroke who were able to walk (61.4 +/-14.9 yr) and compared them with those of an age-matched group of nondisabled subjects (65.1 +/-8.8 yr) and those of a highly functional group of young nondisabled subjects (29.0 +/-5.0 yr). Small (<2%) but significant (p < 0.03) differences were found in RMS values obtained by applying the two most common computational approaches: (1) averaging among individual-stride RMS values and (2) computing the RMS value over the entire walking trial without stride partitioning. We found that the intersubject dependency of acceleration RMS values by selected walking speed was specific for each group and for each of the three body axes. The analysis of ratios between these three accelerations provided informative outcomes correlated with clinical scores and not affected by walking speed. Our findings are an important step toward transferring accelerometry from human movement analysis laboratories to clinical settings.
European journal of physical and rehabilitation medicine
BACKGROUND: The factors that determine successful rehabilitation after lower limb amputation have... more BACKGROUND: The factors that determine successful rehabilitation after lower limb amputation have been widely investigated in the literature, but little attention has been paid to the type of prosthesis and clinical state of the residual limb, particularly the presence of open ulcers. AIM:The aim of this study was to investigate the effects of a vacuum-assisted socket system (VASS) in a sample of trans-tibial amputees with wounds or ulcers on the stump and to evaluate prosthesis use as a primary outcome. Secondary outcome measures were mobility with the prosthesis, pain associated with prosthesis use, and wound/ulcer healing. STUDY DESIGN:Randomized controlled study. SETTING: Inpatient. POPULATION: Twenty dysvascular transtibial amputees suffering from ulcers due to prosthesis use or delayed wound healing post-amputation were enrolled. METHODS:Participants were separated into two groups: the experimental group was trained to use a VASS prosthesis in the presence of open ulcers/wound...
European journal of physical and rehabilitation medicine, 2013
Adolescents with idiopathic scoliosis show a postural instability compared with healthy subjects.... more Adolescents with idiopathic scoliosis show a postural instability compared with healthy subjects. DESIGN TYPE. Case control study. Outpatient clinic of the Complex Operative Unit of Physical Medicine and Rehabilitation of Policlinico Umberto I Hospital. Thirteen patients (11 females and 2 males, mean age 13.3±1.7 years, mean Cobb angle 32±9, median Risser sign 2) and thirteen healthy adolescents (8 females and 5 males, mean age: 13.0±1.6 years) as age-matched control group were enrolled. Postural ability of the participants was assessed with stabilometry (under open eyes and closed eyes conditions), computing sway length, sway ellipse area, and sway velocities. Static and dynamic baropodometry (open eyes only) was used to measure the limb load, and to compute: walking speed, step length, step cadence and step width. The symmetry of left and right limb values was also investigated. Patient's group was characterized by significantly higher postural instability than control group (...
European journal of physical and rehabilitation medicine, 2013
Bilateral transfer, i.e. the capacity to transfer from one to the other hand a learned motor skil... more Bilateral transfer, i.e. the capacity to transfer from one to the other hand a learned motor skill, may help the recovery of upper limb functions after stroke. To investigate the motor strategies at the basis of sensorimotor learning involved in bilateral transfer. Randomized controlled trial. Neurorehabilitation Hospital. Eighty right-handed participants (65 ± 13 years old): 40 patients with subacute stroke, 40 control healthy subjects. Subjects performed the 9 hole-peg-test twice in an order defined by random allocation: first with low and then with high skilled hand (LS-HS) or the reverse (HS-LS). Time spent to complete the test and filling sequence were recorded, together with maximum pinch force (assessed using a dynamometer), upper limb functioning (Motricity Index), spasticity (modified Ashworth Scale), limb dominance (Edinburgh Handeness Inventory). As expected, in patients, the performance was found related to the residual pinch force (P<0.001), upper limb motricity (P=0...
European journal of physical and rehabilitation medicine, 2012
Low back pain is a worldwide health problem, affecting up to 80% of adult population. Psychologic... more Low back pain is a worldwide health problem, affecting up to 80% of adult population. Psychological factors are involved in its development and maintenance. Many clinical trials have evaluated the efficacy of different interventions for chronic non-specific low back pain. In this field, Back School program has been demonstrated effective for people with chronic non-specific low back. To evaluate the relationship between the effects of the Back School treatment and psychological features measured by MMPI-II of patients with chronic non-specific low back pain. A randomised controlled trial with three and six-month follow-up. Ambulatory rehabilitative university centre. Fifty patients with chronic non-specific low back pain out of 77 screened patients. Patients were randomly placed in a 3:2 form and were allocated into two groups (Treatment versus Control). The Treatment Group participated to an intensive multidisciplinary Back School program (BSG, N.=29), while the Control Group recei...
In breast cancer survivors, own body image may change due to physical and psychological reasons, ... more In breast cancer survivors, own body image may change due to physical and psychological reasons, worsening women's living. The aim of the study was to investigate whether body image may affect the functional and quality of life outcomes after a multidisciplinary and educational rehabilitative intervention in sixty women with primary nonmetastatic breast cancer who have undergone conservative surgery. To assess the quality of life was administered The European Organization for Research and Treatment of Cancer Study Group on Quality of Life core questionnaire, while to investigate the psychological features and selfimage were administered the following scales: the Body Image Scale, the Hamilton Rating Scale for Depression, and the State-Trait Anxiety Inventory. To assess the recovery of the function of the shoulder were administered: the Disabilities of the Arm, Shoulder, and Hand Questionnaire and the Constant-Murley Score. Data were collected at the baseline, at the end of the intervention, and at 3-month follow-up. We found a general improvement in the outcomes related to quality of life, and physical and psychological features after treatment (P < 0.001). During follow-up period, a higher further improvement in women without alterations in body image in respect of those with an altered self-perception of their own body was found (P = 0.01). In conclusion, the body image may influence the efficacy of a rehabilitative intervention, especially in the short term of follow-up.
Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in impro... more Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in improving motor performance in patients with chronic stroke, while some recent findings have reported conflicting results for the subacute phase. We aimed to verify whether upper extremity motor rehabilitation could be enhanced by treatment with tDCS administered before a rehabilitative session. Hand dexterity and force in 16 individuals with subacute stroke were assessed before (T0) and after anodal stimulation (T1) and after a successive session of motor rehabilitation (T2) in a double-blind, randomized, sham-controlled, crossover trial. To confirm the value of the device as a specific effector, behavioral tests were also administered. Anodal and sham stimulation plus rehabilitation significantly improved manual dexterity (repeated-measure Anova: A-tDCS: p = 0.005; S-tDCS: p = 0.042). Post hoc analysis revealed a significant stimulation effect only for A-tDCS (p = 0.013 between T0 and T1) a...
Foot drop is a quite common problem in nervous system disorders. Neuromuscular electrical stimula... more Foot drop is a quite common problem in nervous system disorders. Neuromuscular electrical stimulation (NMES) has showed to be an alternative approach to correct foot drop improving walking ability in patients with stroke. In this study, twenty patients with stroke in subacute phase were enrolled and randomly divided in two groups: one group performing the NMES (i.e. Walkaide Group, WG) and the Control Group (CG) performing conventional neuromotor rehabilitation. Both groups underwent the same amount of treatment time. Significant improvements of walking speed were recorded for WG (168±39%) than for CG (129±29%, P = 0.032) as well as in terms of locomotion (Functional Ambulation Classification score: P = 0.023). In terms of mobility and force, ameliorations were recorded, even if not significant (Rivermead Mobility Index: P = 0.057; Manual Muscle Test: P = 0.059). Similar changes between groups were observed for independence in activities of daily living, neurological assessments, and spasticity reduction. These results highlight the potential efficacy for patients affected by a droop foot of a walking training performed with a neurostimulator in subacute phase.
Control of gait is usually altered following stroke, and it may be further compromised by overexe... more Control of gait is usually altered following stroke, and it may be further compromised by overexertion and fatigue. This study aims to quantitatively assess patients' gait stability during six-minute walking, measuring upper body accelerations of twenty patients with stroke (64 ± 13 years old) and ten age-matched healthy subjects (63 ± 10 years old). Healthy subjects showed a steady gait in terms of speed and accelerations over the six minutes. Conversely, the patients unable to complete the test (n = 8) progressively reduced their walking speed (−22±11%, confidence interval CI 95% : −13, −29%, P = 0.046). Patients able to complete the test (n = 12) did not vary their walking speed over time (P = 0.493). However, this ability was not supported by an adequate capacity to maintain their gait stability, as shown by a progressive increase of their upper body accelerations (+5 ± 11%, CI 95% : −1; +12%, P = 0.010). Walking endurance and gait stability should be both quantitatively assessed and carefully improved during the rehabilitation of patients with stroke.
Vision can improve bipedal upright stability during standing and affect spatiotemporal parameters... more Vision can improve bipedal upright stability during standing and affect spatiotemporal parameters during walking. However, little is known about the effects of visual deprivation on gait dynamic stability. We have tested 28 subjects during walking under two different visual conditions, full vision (FV) and no vision (NV), measuring their upper body accelerations. Lower accelerations were found in NV for the reduced walking speed. However, the normalized accelerations were higher in the NV than in the FV condition, both in anteroposterior (1.05 ± 0.21 versus 0.88 ± 0.16, P = 0.001) and laterolateral (0.99 ± 0.26 versus 0.78 ± 0.19, P < 0.001) directions. Vision also affected the gait anteroposterior harmony (P = 0.026) and, interacting with the environment, also the latero-lateral one (P = 0.017). Directly (as main factor of the ANOVA) or indirectly (by means of significant interactions with other factors), vision affected all the measured parameters. In conclusion, participants showed an environment-dependent reduction of upper body stability and harmony when deprived by visual feedback.
Subjects affected by Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am... more Subjects affected by Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease have substantially impaired static and dynamic balance, leading to diminished functional ability. Conventional and innovative exercises have been suggested, but most of them were focused on motor features of posture and gait, deserving poor attention to perceptive aspects of balance. To evaluate the efficacy of the perceptive rehabilitation, based on perceptual surfaces, for postural balance (primary aim) and pain, depression and activity daily living. In this pilot study, we have treated 9 patients with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease undergone rehabilitation aiming to restoring their correct body midline perception, according a schema treatment - no treatment - treatment. During the rehabilitative intervention, both Tinetti balance score (p = 0.007 in both phases) and Tinetti gait score (p = 0.011 and p = 0.016, respectively), such as pain relief assessed by Visual Analogue Scale (p = 0.011, p = 0.010) were improved. Conversely in the phase of no-intervention, lasting the same amount of time, it was showed a significant reduction of Tinetti Balance score (p = 0.010) and no significant changes in terms of Tinetti Gait score and Visual Analogue Scale. These preliminary results highlighted the importance of introducing perceptive training into the exercises proposed to patients with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease for reducing both their static and dynamic balance impairments.
Upright gait is a peculiar characteristic of humans that requires the ability to manage upper bod... more Upright gait is a peculiar characteristic of humans that requires the ability to manage upper body dynamic balance while walking, despite the perturbations that are generated by movements of the lower limbs. Most of the studies on upright gait stability have compared young adults and the elderly to determine the effects of aging. In other studies, the comparison was between healthy subjects and patients to examine specific pathologies. Fewer researches have also investigated the development of upright gait stability in children. This review discusses these studies in order to provide an overview of this relevant aspect of human locomotion. A clear trend from development to decline of upright gait stability has been depicted across the entire lifespan, from toddlers at first steps to elderly. In old individuals, even if healthy, the deterioration of skeletal muscle, combined with sensorial and cognitive performance, reduces the ability to maintain an upright trunk during walking, increasing the instability and the risk of falls. Further, the pathological causes of altered development or of a sudden loss of gait stability, as well as the environmental influence are investigated. The last part of this review is focused on the control of upper body accelerations during walking, a particularly interesting topic for the recent development of low-cost wearable accelerometers.
Motor imagery and internal motor models have been deeply investigated in literature. It is well k... more Motor imagery and internal motor models have been deeply investigated in literature. It is well known that the development of motor imagery occurs during adolescence and it is limited in people affected by cerebral palsy. However, the roles of motor imagery and internal models in locomotion as well as their intertwine received poor attention. In this study we compared the performances of healthy adults (n = 8, 28.1 ± 5.1 years old), children with typical development (n = 8, 8.1 ± 3.8 years old) and children with cerebral palsy (CCP) (n = 12, 7.5 ± 2.9 years old), measured by an optoelectronic system and a trunk-mounted wireless inertial magnetic unit, during three different tasks. Subjects were asked to achieve a target located at 2 or 3 m in front of them simulating their walking by stepping in place, or actually walking blindfolded or normally walking with open eyes. Adults performed a not significantly different number of steps (p = 0.761) spending not significantly different time between tasks (p = 0.156). Children with typical development showed task-dependent differences both in terms of number of steps (p = 0.046) and movement time (p = 0.002). However, their performance in simulated and blindfolded walking (BW) were strictly correlated (R = 0.871 for steps, R = 0.673 for time). Further, their error in BW was in mean only of -2.2% of distance. Also CCP showed significant differences in number of steps (p = 0.022) and time (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), but neither their number of steps nor their movement time recorded during simulated walking (SW) were found correlated with those of blindfolded and normal walking (NW). Adults used a unique strategy among different tasks. Children with typical development seemed to be less reliable on their motor predictions, using a task-dependent strategy probably more reliable on sensorial feedback. CCP showed less efficient performances, especially in SW, suggesting an altered locomotor imagery.
In nature, many physical and biological systems have structures showing harmonic properties. Some... more In nature, many physical and biological systems have structures showing harmonic properties. Some of them were found related to the irrational number known as the golden ratio that has important symmetric and harmonic properties. In this study, the spatiotemporal gait parameters of 25 healthy subjects were analyzed using a stereophotogrammetric system with 25 retroreflective markers located on their skin. The proportions of gait phases were compared with , the value of which is about 1.6180. The ratio between the entire gait cycle and stance phase resulted in 1.620 ± 0.058, that between stance and the swing phase was 1.629 ± 0.173, and that between swing and the double support phase was 1.684 ± 0.357. All these ratios did not differ significantly from each other ( = 0.870, = 0.422, repeated measure analysis of variance) or from ( = 0.670, 0.820, 0.422, resp., t-tests). The repetitive gait phases of physiological walking were found in turn in repetitive proportions with each other, revealing an intrinsic harmonic structure. Harmony could be the key for facilitating the control of repetitive walking. Harmony is a powerful unifying factor between seemingly disparate fields of nature, including human gait.
Transcranial direct current stimulation (tDCS) is a noninvasive technique that is emerging as a p... more Transcranial direct current stimulation (tDCS) is a noninvasive technique that is emerging as a prospective therapy for different neurologic disorders. Previous studies have demonstrated that anodal and cathodal stimulation can improve motor performance in terms of dexterity and manual force. The objective of this study was to determine whether different electrodes' setups (anodal, cathodal, and simultaneous bilateral tDCS) provide different motor performance and which montage was more effective. As secondary outcome, we have asked to the patients about their satisfaction, and to determine if the bilateral tDCS was more uncomfortable than unilateral tDCS. Nine patients with stroke in subacute phase were enrolled in this study and randomly divided in three groups. Our results showed that tDCS was an effective treatment if compared to Sham stimulation (P = 0.022). In particular, anodal stimulation provided the higher improvement in terms of manual dexterity. Cathodal stimulation s...
Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehab... more Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehabilitation's efforts are tended to avoid long-term impairments, but, actually, the rehabilitative outcomes are still poor. Novel tools based on new technologies have been developed to improve the motor recovery. In this paper, we have taken into account seven promising technologies that can improve rehabilitation of patients with stroke in the early future: (1) robotic devices for lower and upper limb recovery, (2) brain computer interfaces, (3) noninvasive brain stimulators, (4) neuroprostheses, (5) wearable devices for quantitative human movement analysis, (6) virtual reality, and (7) tablet-pc used for neurorehabilitation.
La lombalgia cronica (LC) è una patologia molto diffusa con una prevalenza variabile dal 15% al 4... more La lombalgia cronica (LC) è una patologia molto diffusa con una prevalenza variabile dal 15% al 45% nella popolazione 1 . Circa il 90% delle persone lamenta un episodio algico lombare almeno una volta nella vita 2 e nel 5-8 % dei casi 3 è di marcata intensità. Sebbene la maggior parte delle LC si risolva spontaneamente nell'arco di uno o tre mesi, dopo circa un anno il 15% presenta una riacutizzazione della sintomatologia 4 .
Many studies have examined how children with cerebral palsy (CP) manage to walk, but few have inv... more Many studies have examined how children with cerebral palsy (CP) manage to walk, but few have investigated running, yielding controversial results. The aim of this study was to quantitatively assess gait ability and its stability in children with hemiplegic CP while running and walking. A group of 20 children with spastic hemiplegia due to CP (CPG, 5.1 ± 2.3 years old), and a group of 20 children with typical development (TDG, 5.9 ± 2.6 years old) underwent a 10-m walking/running test with a wearable triaxial accelerometer fixed to their lower trunk. Spatiotemporal gait parameters, root mean squares of upper body acceleration, and related harmonic and symmetry ratios were computed. Differences in gait speed were significantly higher during running ( - 19% for CPG with respect of TDG) than during walking ( - 14%, p = 0.028). Conversely, no significant changes were observed in terms of gait stability, and the differences in terms of gait harmony along anteroposterior axis recorded during walking ( - 43%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) disappeared during running ( + 3%, p = 0.834). During running, children with CP are slower than children with TD, but their gait was not less stable, and the harmony of their anteroposterior movements was even more similar to TDG than during walking.
The Journal of Rehabilitation Research and Development, 2012
The analysis of upper-body acceleration is a promising and simple technique to quantitatively ass... more The analysis of upper-body acceleration is a promising and simple technique to quantitatively assess dynamic gait stability. However, this method has rarely been used for people with stroke, probably because of some technical issues still not addressed. We evaluated the root-mean-square (RMS) and harmonic ratio of trunk accelerations for a group of 15 inpatients with subacute stroke who were able to walk (61.4 +/-14.9 yr) and compared them with those of an age-matched group of nondisabled subjects (65.1 +/-8.8 yr) and those of a highly functional group of young nondisabled subjects (29.0 +/-5.0 yr). Small (<2%) but significant (p < 0.03) differences were found in RMS values obtained by applying the two most common computational approaches: (1) averaging among individual-stride RMS values and (2) computing the RMS value over the entire walking trial without stride partitioning. We found that the intersubject dependency of acceleration RMS values by selected walking speed was specific for each group and for each of the three body axes. The analysis of ratios between these three accelerations provided informative outcomes correlated with clinical scores and not affected by walking speed. Our findings are an important step toward transferring accelerometry from human movement analysis laboratories to clinical settings.
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Papers by Augusto Fusco